A revisit of the devastating outcome of leptomeningeal disease.

Abstract

e13504 Background: Leptomeningeal metastasis (LM) represents a devastating complication of malignancies by forming tumor deposits on the leptomeninges at about 5% to 8% of cancer patients (Pts). Standard therapies include radiotherapy (RT) to focal involved areas, systemic and/or intrathecal (IT) chemotherapies which have been recommended for palliation but with unclear benefit toward survival. This study is to review the pattern of the clinical practice and outcomes on Pts with LM who have received care at Henry Ford Hospital between 2004 and 2014 Methods: A retrospective study targeted all Pts of LM (icd-9 code 198.4) between 01/01/2004 and 01/01/2014. Pts with primary brain, orbital and spinal lesions as well as Pts with cord compressions were excluded from this study. LM Pts were included based on MRI images, cerebral spinal fluid (CSF) cytology and/or dural biopsy. Data from onset of primary tumor, therapeutic interventions, methods of LM diagnosis, duration (days) from initial cancer onset to LM diagnosis, then from LM diagnosis to death were collected and analyzed as shown Results: 328 Pts with LM (icd-9: 198.4) were identified, but 58 Pts fulfilled inclusions. Of 58 Pts, 22 (38%) had breast cancer (38%), 12 (21%) NSCLC. LM was diagnosed in 34 Pts (59%) based on MRI findings, 4 (6%) by CSF cytology and 19 (33%) by both. Majority (37 Pts, 64%) received therapy after LM diagnosis: 16 (27%) received IT chemotherapy, 15 (26%) received RT while 6 (10%) received both. Twenty-one of LM Pts (36%) received no treatment under various circumstances. Of 58 Pts, the median time from cancer onset to LM diagnosis was 686 days while median overall survival (OS) was 1038 days, and median OS from LM to death was 95 days. Survival difference was observed for Pts (37, 64%) received LM-directed treatment as 113 days but only 61 days for those received no therapies Conclusions: LM is a prognostic complication in malignancies. It poses a grave challenge due to limited therapeutics that only carry modest survival benefit. Data from these 58 Pts shown a benchmarks of survival from LM diagnosis was 4 months with treatment, and 2 months without. These are consistent with published data over last decades without improvement. Therefore, more clinical researches in LM diagnosis and therapies are needed